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How to grow your mandible + why Ronald Ead's AGGA treatment didn't work as expected

sinned
Estimable Member

One of the major issues with Ronald's AGGA treatment was although he increased his maxilla's length, his mandible didn't change, in his own words he says "Since AGGA made my maxilla longer but did not make my mandible longer simultaneously, it got to the point that my maxilla was so much longer than my mandible that the only way my lower front teeth could meet my upper front teeth in proper occlusion was for my mandible to dislocate forward in the TMJ." I think there is a glaring issue with AGGA treatment that would prevent the mandible from remodeling to match the maxilla, the appliance anchors to the teeth. This is an issue because although his maxilla grew longer, his teeth didn't move forward with the new length.

The Controlled Arch leverages the combined root strength of the front teeth to drag the back teeth forward to close the AGGA gaps. This can be problematic for patients whose front teeth have already been compromised by aggressive AGGA expansion, since using the front teeth for anchorage places additional stress on them.

If his whole arch moved forward in conjunction with his forward maxillary expansion his mandible should have theoretically also remodeled. Because the whole set of his teeth didn't move forward, besides the front teeth, there was no pressure on the lower arch of the teeth/mandible to expand. As a result, his mandible dislocated forward in the TMJ rather than expanding forward to match the maxilla. There is a simple alternative to achieve the same thing and possibly actually getting your mandible to expand forward, push the tongue forward. I mentioned this in a post recently but if you have a vaulted palate it means your palate isn't big enough to fit the tongue, it isn't big enough laterally or longitudinally. 

https://the-great-work.org/community/main-forum/why-you-should-push-the-tongue-forward-for-vaulted-bros/

It's a long read so I'll summarize, let's first differentiate wrongly developed vs underdeveloped, wrongly developed suggests the jaws grew the wrong way, ie, "downswung", underdeveloped means we don't have enough bone or space to house the tongue. Both of these occur, there isn't enough bone or space in the maxilla to fit the tongue, and we're also growing the wrong way. To fit the tongue on the palate you need NEW bone growth. We focus on lateral expansion but we're forgetting that as you grow the tongue grows in LENGTH, not just width. This is how the maxilla is able to grows forwards in all mammals.

Image result for palate sutures

You can even see here there are sutures not just going across the middle, but also horizontally. So as our tongue grows, the maxilla grows in response, as the maxilla grows, the mandible grows in response. 

If your maxilla is too small you will have a vault, shaded in the picture above. To expand your maxilla forward you have to push against the red shaded region. Theoretically, at some point your palate will look like the picture below as it adapts to the stress placed upon it. The palate will fit the tongue perfectly.

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Topic starter Posted : 04/07/2019 1:00 am
TGW liked
Parks
Active Member

have any suggestions for appliances that can expand either the maxilla or the mandible correctly?

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Posted : 04/07/2019 11:40 pm
sinned
Estimable Member

I'm not aware of such an appliance, there already exists appliances that expand your maxilla/palate laterally and there's usually little issue with the mandible not keeping up. https://www.youtube.com/watch?v=R5S5AZ50pAE&feature=youtu.be If you go later in this video the 70 yr old has animated results before and after of his palate and mandible, I think all he wore was a homeoblock appliance. As far as forward expansion, AGGA does achieve forward expansion, with downsides of course, that being it's tooth anchorage not allowing the mandible to keep up. This issue is particular to forward expansion because anchoring to the teeth is not such a bad thing with lateral expansion, this is because the whole arch expands, this is not the case with AGGA. So an appliance that properly expanded the maxilla forward would have to somehow bring the whole arch forward while expanding the maxilla forward. 

The inherent issue with appliances is that your tongue posture is almost always hindered, especially if it's not removable. In addition, appliances are one dimensional, most appliances can only do one thing, the MSE expands your maxilla laterally, AGGA expands it forward, the bow appliance remodels the maxilla forward, the tongue can do all of those things in addition to upswinging the maxilla. In my honest opinion I don't think these appliances are necessary, even if you achieve the change you were looking for, now you're faced with the challenge of creating a new habit of proper tongue/head/body posture to prevent regression. While yes, it would be easier to have correct tongue, head, and body posture if you had a bigger palate, more forward maxilla, and a bigger airway, what makes you think that you'll be able to hold onto the progress that you made if that progress wasn't from the now new habit you need to adopt in order to stop regression. In the lifting world for example, because of the potency of PED's and the rapid results you can get, many people are enticed and delude themselves into thinking that if they just hop on a stack for a year to reach their genetic potential they could then just hop right off and coast/maintain for the rest of their lives, unsurprisingly, this doesn't work. If the results you get aren't from your own efforts, then they won't stick. Going through the struggle of posturing your tongue and head correctly even when your palate is too small and your recessed will only make the habit more permanent. https://www.youtube.com/watch?v=DThVuJ2qlXU To further add to my point, just like exercises won't fix your bad posture, an appliance can not fix your bad posture. You can exercise the muscles involved in posture all you want, strengthen them and build up their tone, that doesn't mean you'll stop slouching. Just because you've hypertrophied and strengthened the muscles involved in posture doesn't mean those muscles will suddenly start creating new neural pathways for a completely different posture/form. In the same vain, you can wear an appliance that expands your maxilla and moves your maxilla forwards, that doesn't mean you'll start posturing your tongue correctly.

Plus, you don't need to spend thousands of dollars on appliances that could possibly not work like you had hoped, like in the case of Ronald who's AGGA appliance, which costed thousands of dollars mind you, hindered his mandibular expansion and possibly damaged his alveolar bone. Let's be honest, as much as people like to criticize mewing for it's lack of results, appliances are in the same boat, so would you rather spend thousands on questionable treatment, become a guinea pig for orthodontists trying to create the NEW and REVOLUTIONARY appliance (which just so happens to cost thousands of dollars), wait years until the messiah of appliances come out that can accomplish everything you hoped for, or just start posturing correctly which costs no money and can actually create a new habit because it's done solely through your efforts alone?

 

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Topic starter Posted : 05/07/2019 12:31 am
GoTTi
Trusted Member
Posted by: sinned

I'm not aware of such an appliance, there already exists appliances that expand your maxilla/palate laterally and there's usually little issue with the mandible not keeping up. https://www.youtube.com/watch?v=R5S5AZ50pAE&feature=youtu.be If you go later in this video the 70 yr old has animated results before and after of his palate and mandible, I think all he wore was a homeoblock appliance. As far as forward expansion, AGGA does achieve forward expansion, with downsides of course, that being it's tooth anchorage not allowing the mandible to keep up. This issue is particular to forward expansion because anchoring to the teeth is not such a bad thing with lateral expansion, this is because the whole arch expands, this is not the case with AGGA. So an appliance that properly expanded the maxilla forward would have to somehow bring the whole arch forward while expanding the maxilla forward. 

The inherent issue with appliances is that your tongue posture is almost always hindered, especially if it's not removable. In addition, appliances are one dimensional, most appliances can only do one thing, the MSE expands your maxilla laterally, AGGA expands it forward, the bow appliance remodels the maxilla forward, the tongue can do all of those things in addition to upswinging the maxilla. In my honest opinion I don't think these appliances are necessary, even if you achieve the change you were looking for, now you're faced with the challenge of creating a new habit of proper tongue/head/body posture to prevent regression. While yes, it would be easier to have correct tongue, head, and body posture if you had a bigger palate, more forward maxilla, and a bigger airway, what makes you think that you'll be able to hold onto the progress that you made if that progress wasn't from the now new habit you need to adopt in order to stop regression. In the lifting world for example, because of the potency of PED's and the rapid results you can get, many people are enticed and delude themselves into thinking that if they just hop on a stack for a year to reach their genetic potential they could then just hop right off and coast/maintain for the rest of their lives, unsurprisingly, this doesn't work. If the results you get aren't from your own efforts, then they won't stick. Going through the struggle of posturing your tongue and head correctly even when your palate is too small and your recessed will only make the habit more permanent. https://www.youtube.com/watch?v=DThVuJ2qlXU To further add to my point, just like exercises won't fix your bad posture, an appliance can not fix your bad posture. You can exercise the muscles involved in posture all you want, strengthen them and build up their tone, that doesn't mean you'll stop slouching. Just because you've hypertrophied and strengthened the muscles involved in posture doesn't mean those muscles will suddenly start creating new neural pathways for a completely different posture/form. In the same vain, you can wear an appliance that expands your maxilla and moves your maxilla forwards, that doesn't mean you'll start posturing your tongue correctly.

Plus, you don't need to spend thousands of dollars on appliances that could possibly not work like you had hoped, like in the case of Ronald who's AGGA appliance, which costed thousands of dollars mind you, hindered his mandibular expansion and possibly damaged his alveolar bone. Let's be honest, as much as people like to criticize mewing for it's lack of results, appliances are in the same boat, so would you rather spend thousands on questionable treatment, become a guinea pig for orthodontists trying to create the NEW and REVOLUTIONARY appliance (which just so happens to cost thousands of dollars), wait years until the messiah of appliances come out that can accomplish everything you hoped for, or just start posturing correctly which costs no money and can actually create a new habit because it's done solely through your efforts alone?

 

I have seen virtually 0 clinical evidence to show that mewing can induce much change, although I believe it can. Meanwhile, I have seen years worth of results from appliances that are used for slow expansion. Pretty much almost all of what you are saying is completely hypothetical and theoretical. I don't believe Ronald didn't experience satisfactory results because of lack of tongue posture, I believe he experienced it from having bad body posture as a whole and was going to relapse regardless. Nobody should expect to retain their results if both the body is still creating imbalances due to postural imbalance and if one is not practicing proper tongue posture in order to  sustain results and make room for more marginal improvements in the future

So, with that being said, one can safely assume that if whole body posture is optimized before, during, & after undergoing slow expansion, and if you have already trained yourself to implement proper tongue posture, there is no way that your body will not maintain gained results and even go on to improve more on top of them simply because your tongue is right there sustaining results and the changes were slow enough to be "accepted" by the subconscious mind. The body can do wonders when you are able to tap into the subconscious mind and work directly with it

About your steroid example, imo you are right and this is in fact the case with anabolic  steroids because the amount of muscle you put on isn't supported by natural hormones asecreted by the body's endocrine system after cycling off and also obviously because the body put on way too much muscle way too fast. This is certainly not the case with slow expansion with a FA provided you continue to practice proper tongue posture after treatment AND as long as the expansion was slow enough.

I also haven't seen any siginificsnt cases of relapse to show for what you're claiming here either.

Interestingly enough, many body builders claim that growth from SARM's are, for the most part, keepable as long as you maintain a normal gym schedule which goes against your steroid and muscle analogy.

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Posted : 08/07/2019 12:16 am
sinned
Estimable Member

@GoTTi

Yes there's no clinical results of mewing and I doubt we'll get any anytime soon. There's no incentive and there's an issue with finding the correct people for a study on mewing. If a person doesn't get any results it's easy to say they didn't mew properly or weren't dedicated enough, and that might or might not be the case, we don't know because we don't have a way of testing if someone is posturing their tongue correctly or for how long or hard they are doing it. So the best we've got are anecdotes and maybe some dedicated few who get monitored by an orthodontist and let's be real no one who starts mewing goes to their orthodontist and asks if they can monitor their results. In general, I don't believe appliances can fix posture, however, I say that generally, in Ronald's case, I think the appliance itself is flawed in that it doesn't allow the mandible to keep up and possibly damages the alveolar bone. Not only that, it's clear that appliances are able to expand the maxilla, there's plenty of proof of that, yet there's sparse if any proof/results showing appliances can upswing the maxilla, and it's my opinion that appliances aren't capable of maxillary rotation. Furthermore rotating the maxilla might be one of the most pertinent issues in CFD, other than lateral palate expansion, how are you going to improve the airway? So far, I've only seen mewing actually capable of upswinging the maxilla, off the top of my head, neveragain/Jamo, Progress, and helmutstrebl (although he's more suspect) have seemingly upswung the maxilla.

I'd also like to address something else, I said that there doesn't exist an appliance that expands the maxilla forward while allowing the mandible to keep up but now I believe I'm wrong, I also said that the bow appliance remodels the maxilla forward and I think I'm wrong in that case as well. I said that in order to have an appliance expand the maxilla forward while also allowing the mandible to keep up it would have to bring the whole arch forward as well, now that I think about it, facepulling headgear like the bow appliance accomplishes exactly that. If that's the case, then does facepulling headgear actually remodel the maxilla forward or does it make the maxilla longer? I'm not sure but I'm inclined to think that facepulling headgear actually expand the maxilla forward. And I also believe that the only way to remodel the maxilla forward is through maxillary rotation, which so far no appliance has managed to accomplish. If I assume this then the results from facepulling headgear make sense, many before and afters show no improvement in the position/angle of the maxilla, although it seemingly went forward, however how could the maxilla only remodel forward? I think that it's impossible to remodel the maxilla in only direction and the actually remodeling of the maxilla happens through upswinging/maxillary rotation. 

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Topic starter Posted : 08/07/2019 3:08 am
GoTTi liked
GoTTi
Trusted Member
Posted by: sinned

@GoTTi

Yes there's no clinical results of mewing and I doubt we'll get any anytime soon. There's no incentive and there's an issue with finding the correct people for a study on mewing. If a person doesn't get any results it's easy to say they didn't mew properly or weren't dedicated enough, and that might or might not be the case, we don't know because we don't have a way of testing if someone is posturing their tongue correctly or for how long or hard they are doing it. So the best we've got are anecdotes and maybe some dedicated few who get monitored by an orthodontist and let's be real no one who starts mewing goes to their orthodontist and asks if they can monitor their results. In general, I don't believe appliances can fix posture, however, I say that generally, in Ronald's case, I think the appliance itself is flawed in that it doesn't allow the mandible to keep up and possibly damages the alveolar bone. Not only that, it's clear that appliances are able to expand the maxilla, there's plenty of proof of that, yet there's sparse if any proof/results showing appliances can upswing the maxilla, and it's my opinion that appliances aren't capable of maxillary rotation. Furthermore rotating the maxilla might be one of the most pertinent issues in CFD, other than lateral palate expansion, how are you going to improve the airway? So far, I've only seen mewing actually capable of upswinging the maxilla, off the top of my head, neveragain/Jamo, Progress, and helmutstrebl (although he's more suspect) have seemingly upswung the maxilla.

I'd also like to address something else, I said that there doesn't exist an appliance that expands the maxilla forward while allowing the mandible to keep up but now I believe I'm wrong, I also said that the bow appliance remodels the maxilla forward and I think I'm wrong in that case as well. I said that in order to have an appliance expand the maxilla forward while also allowing the mandible to keep up it would have to bring the whole arch forward as well, now that I think about it, facepulling headgear like the bow appliance accomplishes exactly that. If that's the case, then does facepulling headgear actually remodel the maxilla forward or does it make the maxilla longer? I'm not sure but I'm inclined to think that facepulling headgear actually expand the maxilla forward. And I also believe that the only way to remodel the maxilla forward is through maxillary rotation, which so far no appliance has managed to accomplish. If I assume this then the results from facepulling headgear make sense, many before and afters show no improvement in the position/angle of the maxilla, although it seemingly went forward, however how could the maxilla only remodel forward? I think that it's impossible to remodel the maxilla in only direction and the actually remodeling of the maxilla happens through upswinging/maxillary rotation. 

You definitely are a critical thinker which is a very good thing. I share similar thoughts about certain things you've mentioned and also go around saying some of the same things you've stated up above in regards to having to accept some of these anecdotes for now. You are definitely on point with your logic here and I definitely was not implying that mewing does not work when I mentioned there being 0 clinical evidence. When I stated that, I stated it to get my point across on there being solid research I can show you on palatal expanders working. I kind of felt like you were down talking appliances, so I had to refute that. But you did correct yourself and that's all that matters. I'm still learning about all of this stuff myself but that I knew for sure since I've been obsessing about this type of research for some time now.

 I'm going to type up a response to this tomorrow as it's very late where I'm at right now. But I did want to mention that I did enjoy your post and appreciate you for not falling Vitim to dogmatic thinking.

PS: I'd like to hear more about your theories on the BOW appliance on adults. Very interesting viewpoints coming from your end, buddy 

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Posted : 08/07/2019 3:40 am
entelechy
Trusted Member

@sinned

I love your approach---and I too believe in the independent way to change the body.  But there's a big if in the equation.  What if the adult palate cannot expand?     So your tongue can press all it wants, but it will get slight if any bone change results. 

I do mouth-pulling, tongue pushing, mewing, all of it---I THINK I am making things better, and I can say for a fact that I moved my cramped TEETH farther apart by constant pressure with my tongue.  But I look at that missing 5 mm of longitudinal palate  I need--and I ask: am I deluding myself?

 

entelechy

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Posted : 20/11/2019 7:11 pm
ForTheFuture
Active Member

@entelechy

I think the palate can expand in adults. However, I'm starting to think that if you want any kind of horizontal expansion in the maxilla, you have to split the suture first. I theorize that since most of the actual "growth" is done, "guiding" the growth will give very minimL results.

MSE worked wonders for Ronald Ead, and gave him 11.5 mm of horizontal expansion. But the suture had to be split by the device first, which required three days of constant force applied directly to the bone, as well as punctures in the maxilla to make it more likely to split.

Perhaps this means that intensive enough thumb pulling can split the suture? Or maybe the force just isn't constant enough, even if you did it 5 minutes every hour. Also, is it dangerous to split the suture without a device holding the two pieces of the maxilla together? And is the force of the tongue going to be enough to create expansion once the suture is split? Because with MSE, the device is doing most of the work for you.

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Posted : 21/11/2019 8:36 am
entelechy
Trusted Member

You can't split the suture with the tongue.  Too strong bond.   What I have accomplished with the tongue (I think) is moving the alvealor ridge.   Palate is the same

I will be spending the day with Dr. Moon tomorrow--

entelechy

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Posted : 21/11/2019 10:32 am